To the Editor: In the study by Dr Neeland and colleagues,1 a cohort of 732 obese adults was followed up for a mean of 7 years. The authors evaluated the association of measures of adiposity and fat distribution with incident prediabetes and diabetes and investigated whether these relationships were independent of several established risk factors. Excess visceral fat mass (measured by magnetic resonance imaging) and insulin resistance (estimated from fasting blood glucose and insulin levels, but not general adiposity) were independently associated with incident prediabetes and diabetes. The authors concluded that these findings may help to better understand the metabolically healthy obese phenotype.